Several forms of vitamin K are used in dietary supplements, including vitamin K1 as phylloquinone or phytonadione (a synthetic form of vitamin K1) and vitamin K2 as MK-4 or MK-7 [20]. Phylloquinone in plant foods is tightly bound to chloroplasts, so it is less bioavailable than that from oils or dietary supplements [1]. 6 0 obj For example, the body absorbs only 4% to 17% as much phylloquinone from spinach as from a tablet [2]. People taking warfarin and similar anticoagulants need to maintain a consistent intake of vitamin K from food and supplements because sudden changes in vitamin K intakes can increase or decrease the anticoagulant effect [47]. *DV = Daily Value. Vitamin K should be given orally or intravenously only; do not inject it subcutaneously or intramuscularly. (See Box Warning.) The Ann Pharmacother 2003;37:510-2. These compounds include phylloquinone (vitamin K1) and a series of menaquinones (vitamin K2) [2]. Whenever possible, Vitamin K1 Injection (Phytonadione Injectable Emulsion, USP) should be given by the subcutaneous route. At 24 hours, the effects of 5 mg of oral vitamin K on INR is roughly equal to 1 mg of intravenous vitamin K.2 Generally use doses of 2.5 to 5 mg. It reduces the body's absorption of dietary fat and in doing so, it can also reduce the absorption of fat-soluble vitamins, such as vitamin K. Combining orlistat with warfarin therapy might cause a significant increase in prothrombin time [50]. In 2006, Cockayne and colleagues conducted a systematic review and meta-analysis of randomized controlled trials that examined the effects of vitamin K supplementation on bone mineral density and bone fracture [37]. Pharmacotherapy 2002;22:814-22. 2008;158:385-95. Parenteral administration of vitamin K replacements (including AquaMEPHYTON) may cause cutaneous reactions. Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals. Demer LL, Tintut Y. Vascular calcification: pathobiology of a multifaceted disease. Important information to know when you are taking: warfarin (Coumadin) and vitamin K. Chicken, breast, rotisserie, 3 ounces (as MK-4), Chicken liver, braised, 3 ounces (as MK-4), Ham, roasted or pan-broiled, 3 ounces (as MK-4), Salmon, sockeye, cooked, 3 ounces (as MK-4). Although the full biological function of MGP is unclear, a hypothesis based on animal data suggests that inadequate vitamin K status leads to undercarboxylated MGP, which could increase vascular calcification and the risk of coronary heart disease. Correction of Vitamin K antagonist- impairment of hemostasis is reached at the latest 30 min after the injection and will persist for ~ 6-8 hrs. Meat, dairy foods, and eggs contain low levels of phylloquinone but modest amounts of menaquinones [4]. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.". In adults aged 20 and older, the average daily vitamin K intake from foods is 122 mcg for women and 138 mcg for men. [, Geleijnse JM, Vermeer C, Grobbee DE, Schurgers LJ, Knapen MH, van der Meer IM, et al. One study found that both phytonadione and MK-7 supplements are well absorbed, but MK-7 has a longer half-life [21]. J Nutr 2011;141:1847-54. Dietary Guidelines for Americans. In the circulation, vitamin K is carried mainly in lipoproteins [2]. According to the updated CHEST guidelines, vitamin K should be administered based on INR level and degree of … The American Academy of Pediatrics recommends that all newborns, whether breastfed or formula fed, receive a one-time intramuscular shot of vitamin K 1 (phytonadione) at a dose of 0.5 to 1.0 milligrams shortly after birth (this is usually given during the birth hospitalization). The following groups are among those most likely to have inadequate vitamin K status. Vitamin K can have a serious and potentially dangerous interaction with anticoagulants such as warfarin (Coumadin®), as well as phenprocoumon, acenocoumarol, and tioclomarol, which are commonly used in some European countries [7,8]. Drug-Nutrient Interaction Task Force, Clinical Center, National Institutes of Health. Menaquinones, which are predominantly of bacterial origin, are present in modest amounts in various animal-based and fermented foods [1,4]. Washington, DC: National Academy Press; 2001. Prothrombin (clotting factor II) is a vitamin K-dependent protein in plasma that is directly involved in blood clotting. Controversies concerning vitamin K and the newborn. Am J Clin Nutr 1999;69:74-9. Incidence rates at the country level were mostly unknown (6/23) or not supported by adequate data (13/23). Parenteral drug products should be inspected visually for particulate matter and discoloration prior to admini… The authors noted the importance of considering the effect of vitamin D on bone health when comparing the results of vitamin K supplementation studies, especially if both vitamin K and vitamin D (and/or calcium) are administered to the treatment group but not the placebo group [40]. Osteoporosis prevention, diagnosis, and therapy. Get the latest public health information from CDC: https://www.coronavirus.gov Washington, DC: Wiley-Blackwell; 2012:230-47. Vitamin K1 (phylloquinone) has a phytyl side chain. In healthy people, fasting concentrations of phylloquinone in plasma have been reported to range from 0.29 to 2.64 nmol/L [12]. Because vitamin K is required for the carboxylation of osteocalcin in bone, vitamin K deficiency could also reduce bone mineralization and contribute to osteoporosis [25]. Osteoporos Int 2013;24:2499-507. These findings might be particularly relevant for patients with chronic kidney disease because their rates of vascular calcification are much higher than those of the general population [9]. Effects of orlistat on fat-soluble vitamins in obese adolescents. People with plasma phylloquinone concentrations slightly below the normal range have no clinical indications of vitamin K deficiency, possibly because plasma phylloquinone concentrations do not measure the contribution of menaquinones from the diet and the large bowel [12]. Thus, poultry and pork products contain MK-4 if menadione is added to the animal feed [1,4,14]. Osteoporos Int 2006;17:1122-32. They can also reduce the absorption of vitamin K and other fat-soluble vitamins, although the clinical significance of this effect is not clear [48,49]. Recommendations on Vitamin K: Vitamin K should be given to all newborn infants as a single, intramuscular dose of 0.5 to 1 mg. Additional research should be conducted on the efficacy, safety, and bioavailability of oral vitamin K to prevent late vitamin K deficiency bleeding. In Japan and other parts of Asia, a pharmacological dose of MK-4 (45 mg) is used as a treatment for osteoporosis [5]. However, the forms and amounts of vitamin K in these foods likely vary depending on the bacterial strains used to make the foods and their fermentation conditions [14]. In a recently released study in Pediatrics, Jaspreet Loyal and colleagues (10.1542/peds.2017-3743) examine factors associated with refusal of intramuscular vitamin K by parents of normal newborns admitted to newborn nurseries in the BORN (Better Outcomes through Research for Newborns) … Calcif Tissue Int 2012;90:396-403. [. Babies have low levels of vitamin K at birth, and the current IM dose will supply their need for vitamin K until they have another source from his or her diet.² [, Pichler E, Pichler L. The neonatal coagulation system and the vitamin K deficiency bleeding - a mini review. Adv Nutr 2013;4:463-73. Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. Vitamin K functions as a coenzyme for vitamin K-dependent carboxylase, an enzyme required for the synthesis of proteins involved in hemostasis (blood clotting) and bone metabolism, and other diverse physiological functions [3,5]. <> Vitamin K treatment reduces undercarboxylated osteocalcin but does not alter bone turnover, density, or geometry in healthy postmenopausal North American women. People with malabsorption syndromes and other gastrointestinal disorders, such as cystic fibrosis, celiac disease, ulcerative colitis, and short bowel syndrome, might not absorb vitamin K properly [3,5,25]. maternal vitamin K supplements of 5mg/day (800% RDA) has been shown in one study to raise infant serum levels to near formula-fed levels, but there is no FDA approved MVI that contains this amount of vitamin K �{&�i:߱27]��7��H?���=T!��0�0$4G�Hԕwi�Ǎ54��n�>I�ɂ�k�ƍ�"X���6A�c@��a��a;>/g2,=%���8.�?imQXv���:���Z�iN�:�bi�������u��r�� 6 Intravenous vitamin K can lower the INR more quickly than oral vitamin K, but at 24 hours, intravenous and oral vitamin K produce similar … At this time, the role of the different forms of vitamin K on arterial calcification and the risk of coronary heart disease is unclear, but it continues to be an active area of research in the general population and in patients with chronic kidney disease [5,9,46]. A dosage of 2.5 to 25 mg or more (rarely up to 50 mg) is recommended, the amount and route of administration depending upon the severity of the condition and response obtained. All participants also received daily supplements containing 630 mg calcium and 400 IU vitamin D3. about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. The federal government's 2015-2020 Dietary Guidelines for Americans notes that "Nutritional needs should be met primarily from foods. Vitamin K nutrition, metabolism, and requirements: current concepts and future research. <> Diet. Furthermore, among those with coronary artery calcification at baseline, phylloquinone treatment reduced calcification progression by 6% compared to the control group. Dosing guidelines for rapid reversal in preparation for invasive procedure: 1. Food Nutr Res 2012;56. [, Shearer MJ, Fu X, Booth SL. Circulation 2008;117:2938-48. 2 0 obj Menaquinone intake was also inversely associated with severe aortic calcification in a prospective, population-based cohort study involving 4,807 men and women aged 55 years and older from the Netherlands [43]. Food sources of phylloquinone include vegetables, especially green leafy vegetables, vegetable oils, and some fruits. Vitamin K Administration in Newborn Infants; Infectious Disease. The only clinically significant indicator of vitamin K status is prothrombin time (the time it takes for blood to clot), and ordinary changes in vitamin K intakes have rarely been shown to alter prothrombin time [5]. Orlistat enhances warfarin effect. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. Updated: June 3, 2020 History of changes to this fact sheet, U.S. Department of Health & Human Services, Strengthening Knowledge and Understanding of Dietary Supplements, My Dietary Supplement and Medicine Record, How To Evaluate Health Information on the Internet, NIH Consortium for Advancing Research on Botanical and Other Natural Products (CARBON) Program, Analytical Methods and Reference Materials (AMRM), Dietary Supplement Ingredient Database (DSID), Computer Access to Research on Dietary Supplements (CARDS) Database. Based on these findings, the authors did not make any clinical recommendations, and they called for larger studies in other populations. Food Labeling: Revision of the Nutrition and Supplement Facts Labels and Serving Sizes of Foods That Can Reasonably Be Consumed at One Eating Occasion; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments; Proposed Extension of Compliance Dates. Many respondents (17/23) indicated that vitamin K prophylaxis is included in their national newborn care guidelines and policies, while 12 respondents indicated that administration … These individuals might need monitoring of vitamin K status and, in some cases, vitamin K supplementation. [, Schurgers LJ, Vermeer C. Determination of phylloquinone and menaquinones in food. High dietary menaquinone intake is associated with reduced coronary calcification. [, Rejnmark L, Vestergaard P, Charles P, Hermann AP, Brot C, Eiken P, et al. Vitamin K deficiency bleeding or VKDB, is a condition that occurs when the baby does not have enough Vitamin K. Without enough vitamin K, your baby has a chance of bleeding into his or her intestines, and brain, which can lead to brain damage and even death. Vitamin K supplementation and progression of coronary artery calcium in older men and women. All of these trials used MK-4 at either 15 mg/day (1 trial) or 45 mg/day (6 trials). 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